Democrats Resort to Magical Thinking on Obamacare

By Ramesh Ponnuru -
Apr 2, 2012

In the span of one week, Democrats
went from dismissing the possibility that the Supreme Court
would strike down the 2010 law mandating individuals to buy
health insurance to consoling themselves that any such action
would have a silver lining.

James Carvillesays it would help the Democrats in the
election. Washington Post columnist Eugene Robinson writes that
it would make single payer -- a government health system as in
the U.K. and Canada -- “inevitable.” Otherliberals, and even
the occasional right-of-center analyst, have echoed that point:
The conservative legal challenge to President Barack Obama’s
health-care overhaul could prove self-defeating.

It’s an interesting and counterintuitive analysis, but it’s
almost certainly wrong. If the court undoes Obamacare, either in
whole or in part, conservatives who would like to reduce the
government’s role in health care are likely to get policies much
more to their liking.

Let’s say the court strikes down the entire law. The
Democratic fantasy goes something like this: The public will
still be upset about the number of Americans without insurance,
rising premiums and the difficulty people with pre-existing
conditions have getting insurance. Republicans will have no plan
for achieving universal coverage. Sooner or later, single payer
-- which would probably be more popular than a mandate, and thus
an easier sell to the public -- will prevail.

Political Reality

Reality-check time: When Obamacare became law, Democrats
had more power in Washington than at any time since the Carter
administration in the 1970s. They had the presidency and
lopsided majorities in both houses of Congress. Because
conservative Democrats have declined in numbers, it was probably
the most liberal Congress since 1965-66. They were still barely
able to pass the law. And that was with important medical
industries either neutralized or in favor of the legislation,
which they would not be in the case of single payer.

Democrats attained that degree of power because of an
unusual set of circumstances: an unpopular Republican president
reaching the end of his second term and a financial crisis
hitting at exactly the right time. The odds are that it will be
a long, long time until Democrats again hit the jackpot. And
without an overwhelming Democratic majority, getting single
payer through Congress would be almost impossible: Republicans
won’t acquiesce to any steps toward such a system.

It’s true that people like the idea of helping the
uninsured and those with pre-existing conditions, but the
support melts away when this help involves higher taxes or
intrusive regulation. Look at it this way: For several years,
fans of the health-care law have been saying that any day now
the popularity of Obamacare’s regulation of insurance companies
would start trumping the unpopularity of other parts of the
legislation. It hasn’t happened yet, and there is no reason to
think it would once the court struck down the law.

Or let’s say the court strikes down the mandate, but leaves
in place the insurance regulations. The regulations without the
mandate would lead healthy people to drop their coverage -- the
insurance rules mean such people would be able to get it again
if they get sick -- and with only ill people covered, premiums
would soar.

The question then becomes: Would Congress be more likely to
respond by moving to single payer or by getting rid of the
regulations?

We have seen just this scenario play out in a number of
states that imposed similar regulations without any mandate.
Iowa, Kentucky, New Hampshire and South Dakota have all repealed
their regulations, while Maine, New Jersey and Washington State
have weakened theirs. Only liberal Vermont, according to a study
conducted by America’s Health Insurance Plans, a trade group,
has moved toward single payer.

Clearing the Way

In those cases, of course, the Supreme Court wasn’t
involved. Democrats would be outraged if the court struck down
the mandate, and would presumably blame any resulting problems
in the health-care market on its decision. Republicans,
meanwhile, would blame the Democrats for enacting a flawed law
that couldn’t survive legal scrutiny.

The public is likely to side with the court, for two
reasons. Americans express significantly more confidence in the
court than in the presidency or Congress. And most Americans
dislike the individual mandate and actually want it struck down.

None of this means conservatives will get their way on
health-care policy across the board. Presumably, Democrats will
continue to resist Representative Paul Ryan’s plan to transform
Medicare, or a revival of Senator John McCain’s proposal to let
people buy insurance across state lines and give them tax
credits. Many liberals think those policies would be just as
disastrous as most conservatives think Obamacare would be. But
such reforms seem at least as likely as single payer to make
headway. And Obamacare’s demise would clear the way for them.

(Ramesh Ponnuru is a Bloomberg View columnist and a senior
editor at National Review. The opinions expressed are his own.)